From the Research
Needle drainage of a Bartholin cyst is indicated when the cyst is symptomatic, causing pain, discomfort during walking or sitting, or interfering with sexual activity, and is less than 3 cm in size, as stated in the most recent study 1. This procedure is most appropriate for patients who need immediate relief but cannot undergo more definitive surgical management, or for those with recurrent cysts who are familiar with the drainage procedure. The procedure involves using a 16-18 gauge needle to aspirate the cyst contents after cleaning the area with antiseptic solution and administering local anesthesia (1% lidocaine). However, needle drainage should be considered a temporary solution as it has a high recurrence rate of approximately 80% 2. It is contraindicated in cases of abscess formation, which would require incision and drainage or marsupialization. Some key points to consider when deciding on the treatment approach include:
- The size and location of the cyst or abscess
- The patient's overall health and medical history
- The patient's preferences and values
- The potential risks and benefits of each treatment option Patients should be advised that while needle aspiration provides immediate relief, they may need more definitive treatment such as marsupialization, Word catheter placement, or gland excision for long-term resolution. Following drainage, patients should be instructed to take sitz baths 2-3 times daily and may benefit from over-the-counter pain relievers like ibuprofen (400-600 mg every 6 hours) or acetaminophen (500-1000 mg every 6 hours) for residual discomfort. Recent studies have compared the effectiveness of different treatment options, including marsupialization and Word catheter placement, with mixed results 3, 1. However, the most recent study suggests that marsupialization may be the preferred treatment option due to its lower recurrence rate and higher patient satisfaction scores 1. Ultimately, the decision on which treatment approach to use should be made on a case-by-case basis, taking into account the individual patient's needs and circumstances.